“A Welcomed Addition” to the ACGME Parental Leave Policy. A Summary for Program Leadership to Aid Physicians-in-training with Becoming Physician Parents-in-training

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Post graduate medical training is a busy time of personal and professional growth. For many residents and fellows, this will also be a time to welcome new additions to their families. That’s right we are talking about babies! Learning that you will be welcoming an addition your family can come with wide range of emotions and add to the already stressful life during residency or fellowship. How can we as program leadership help residents and fellows with the transition to parenthood during training?

 

As program directors, associate program directors and core faculty it is important to create a culture of understanding and communication. For those residents or fellows expecting new additions there is a strong focus on getting ready for the baby’s arrival, whether this is from pregnancy, surrogacy or adoption/fostering. What life will be like when returning to training can seem so distant, leaving trainees feeling overwhelmed and under-prepared. Often our role is to act as a guide through the process of scheduling request, leave of absence paperwork, policy translation and even mentor their new role as parent-trainee.

 

While there is no perfect recipe for baby planning, we have a few suggestions as both program directors and recent moms.

 

The biggest theme to remember is that communication is key. It is important to set a foundation where residents and fellows can approach program leadership to discuss leave of absence related to a new child. Circumstances around this are ever evolving and open lines of communication will help avoid stress to all trainees (pregnant or non-pregnant).

 

It is important to understand the policies of the ACGME, various federal, state and institutional policies (including human resource and FMLA policies) and certifying boards (ABMS). In July 1, 2022 new institutional requirements went into effect mandating sponsoring institutions to have leave policies that include a minimum of six paid weeks off for medical, parental, and caregiver leave. The Institutional Review Committee will site sponsoring institutions for violations of the new requirements beginning July 1, 2023.

 

The actual requirements “provide residents/fellows with a minimum of six weeks of approved medical, parental and caregiver leave of absence for qualifying reasons that are consistent with applicable laws at least once and at any time during an ACGME-accredited program, starting the day the resident/fellow is required to report.” Institution must provide residents/fellows with at least the equivalent of 100 percent of their salary for the first six weeks of the first approved medical, parental or caregiver leave of absence taken. This does not mandate vacation or sick day be used. It does mandate that six weeks must be paid and at least one week of paid time off must be reserved for use outside of these six weeks.

 

Section VI of the ACGME Common program requirements reference “commitment to the well-being of the students, residents, faculty members, and all members of the health care team.” This includes protected time for lactation, medical appointments, mental health care, and coverage for family emergencies.

 

ABMS policy states that for initial certification in Pulmonary or Critical Care medicine, the trainee “must complete a minimum of three years of accredited combined training, 18 months of which must be clinical training.” The six week of absence policy is also recognized by ABMS as a minimum of time allowed off during training. If the initial certification is not met, then extended time is expected to be added to the training. Competency of all required procedures is still to be discussed and reviewed during the Clinical Competency Committee meeting and should anyone be delinquent, should it be due to time off or other reasons, extended time is recommended.

 

Scheduling will likely be of most concern to the trainee. While we all acknowledge that babies have a timeline all their own, by having a foundation of clear communication and knowledge of the policies, program leadership can decrease the stress of expecting residents and fellows.  This includes being mindful of rotation and call schedules pre and post baby, helping establish clinic, pager and electronic health record coverage during leave, and the return to the training schedule. All new parents are sleep deprived and struggle with the transition back to training.  Be mindful that not all pregnancies and babies are “normal”. There are circumstances that may complicate a return to normal training; medical for mom and/or baby, legal for adoptions or surrogacies. During these unusual circumstances, a good foundation of communication and program culture can help avoid extending training.

 

While each training program is unique these are some ideas to consider when creating a schedule for parental leave.

  1. Expectant or adoptive parents should notify the program director and those responsible for scheduling of rotations and call as soon as pregnancy is confirmed.
  2. Coverage of responsibilities should be arranged as soon as possible.
  3. Consider scheduling more demanding rotations (ie, night float or those with a larger portion of in house call) earlier in the pregnancy.
  4. Schedule rotations where the resident is “non-essential” around the estimated due date.
  5. Avoid scheduling call assignments around the estimated due date.
  6. Set expectations that call, and weekend assignments will be equal for expecting parents and other trainees to avoid other trainees feeling disadvantagedto avoid other trainees feeling disadvantaged.

 

Allowing for less intense schedule at the time of return is helpful to trainees to allow for flexibility during a time of adjustment. This could include less demanding rotations like night call or a busy consult or procedure service. Using this time for outpatient-based rotations, electives or other selectives may be more appropriate. Once your resident/fellow comes back from their parental leave, you should set up a time to have a meeting with them.

 

Since you have laid out a plan prior, it is helpful to check in on their well-being and review previously set expectations.  Keeping the lines of communication open early on are fundamental in making sure that the transition into this new life is met as seamlessly as possible. The trainee will not likely anticipate the disruptions in their normal schedule, and you can help be a resource for that. Residency and fellowship are times of high intensity education, but if the trainee is stressed and not relaxed, they may not be able attain the education they are looking for. Ensuring they are on less demanding rotations and being mindful of call and night float assignments, can be helpful to ease their transition back to clinical work.

 

For female trainees that choose to breastfeed, setting up time for pumping will be extremely important. American Association of Pediatricians recommends breast feeding for the first six months, but go further and recommend breast milk be part of the diet up to two years. Making sure the trainee has adequate space, time and resources will help to make this as stress free as possible. Things that are helpful include, but not limited to: a private room that has a computer so work can be done as needed, a refrigerator to store milk, washing station to clean parts, storage and outlet for equipment. All faculty should be made aware the trainee will be taking breaks to do this. They may feel awkward, especially to male colleagues, to have to ask for this time. Some programs have offered to pay for wireless pumps so the trainee can still work while pumping, but will likely still need a few minutes to prepare and remove, more akin to a bathroom break (not all trainees can afford these expensive pumps and not all women produce milk with these pumps). The trainee will also need to stay adequately hydrated and nourished throughout the day to maintain a supply, so they should be aware to not be hesitant to take frequent meal breaks.

 

Remember your male trainees, adoptive or parents who utilized a surrogacy may not have given birth, but they are also adjusting to life with a new baby. This is also taxing and demanding and should not be minimized. Take a moment to ensure the trainee has access to the wellness resources available through your institution. As a physician we think we are used to sleep deprivation, but being a new parent is a whole new level of exhaustion and can take a toll on anyone. They may be at high risk for post-partum depression and/or anxiety due to all the new factors that play a role in their life. Childcare is inevitable and adds additional stress and not all trainees have the luxury of being near a support system. Providing guidance during the pre-leave can help decrease this stress. Some institutions have access to services that can help with childcare accommodations, even in emergency situations. Make sure they are aware of the resources available and emphasize that it is normal to ask for help.

 

Check in frequently with your trainee, especially at the beginning. Help them to get acclimated to a new life and know that it will not be this way forever. As the baby goes through regressions and progressions, every day is going to be different. Talking about the good things, sharing your experiences, and sharing memories will help to make sure they know they are not alone in this and hopefully allow for as smooth a transition as possible.

 

Keriann Van Nostrand, MD is an Associate Professor of Medicine and pulmonary, critical care medicine Program Director and interventional pulmonologist at the University of South Florida Morsani School of Medicine. Her interests include benign airway disease, lung cancer screening and teaching EBUS and rigid bronchoscopy. When she is not at work, she enjoys spending time with her husband, 15 month old son and 4 year old Schnoodle.

Elizabeth Awerbuch, DO is an Assistant Professor of Medicine and Medical Education at the Icahn School of Medicine. She is currently the Program Director for the Pulmonary/Critical Care Medicine fellowship at Elmhurst Hospital Center in Queens, New York. She completed her Internal Medicine residency training at St. Luke’s-Roosevelt Hospital and Pulmonary/Critical Care fellowship training at Beth Israel Medical Center in New York. She went to medical school at the Philadelphia College of Osteopathic Medicine.

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